The president of the University of Texas M.D. Anderson Cancer Center has been granted a limited waiver from the institution's conflict-of-interest policy, allowing him to maintain financial ties with his three principal pharmaceutical companies.

Dr. Kenneth Shine, the UT System's vice chancellor for health affairs, revealed the decision in a letter to Dr. Ronald DePinho, the center's president. The letter, made available Tuesday, said DePinho's holdings in Aveo, Karyopharm and Metamark will be placed in a blind trust as part of the waiver.

DePinho requested a multi-company waiver in April.

"Not allowing patients to have the benefit of clinical trials or other agents from these companies would not be in the patient's best interests as long as adequate safeguards are in place," wrote Shine. "At the same time I have concluded that allowing a waiver for a particular relationship must be a very limited event, particularly in view of the need for scrupulous oversight of each trial and in view of the principle that a waiver is granted only in exceptional circumstances."

In an interview with the Houston Chronicle, Shine said "elaborate, detailed" provisions would be applied to any research involving companies in which DePinho has financial interests. He said consent forms for all trials involving the companies will disclose those relationships to patients.

Request called 'brash'

In an email to M.D. Anderson employees Tuesday, DePinho applauded the decision, saying it "confirms M.D. Anderson's focus on protecting our patients first and making great strides in accomplishing our mission to eliminate cancer."

DePinho's original request named 10 for-profit companies and two not-for-profit institutions where he has financial ties - equity interest, intellectual property rights or past or possible future compensation.

One expert called DePinho the "quintessential multi-vested scientist administrator" and said his request was the "most brash" he'd ever heard of.

Shine said that for the other companies named in DePinho's request, the M.D. Anderson president has divested or will divest most of his interests in "a timely manner" or "no waiver was required or granted at the present time."

Shine gave no breakdown of which requests didn't require waivers, and declined to give a timeline of DePinho's remaining divestitures.

Aveo, Karyopharm and Metamark are the companies in which DePinho has the greatest interest - he co-founded Karyo­pharm and Metamark and owns nearly $4.9 million of stock in Aveo. The companies are also the most likely to propose trials at M.D. Anderson.

Aveo announced such a trial at M.D. Anderson and other centers in May, but it still awaits approval from a review board that evaluates institutional research for patient safety.

Shine said the decision was based on a number of factors, but he emphasized DePinho's "unique history and experience in developing new agents to help patients and to create companies and procedures which would bring research results to the bedside." He noted that Aveo, Karyo­pharm and Metamark were mentioned in the employment offer he sent to DePinho.

That letter stipulated that DePinho could continue on the Aveo board of directors, prohibited in M.D. Anderson's conflict of interest policy. In Tuesday's decision, Shine stood by that pledge, but required that DePinho's wife, Lynda Chin, who joined M.D. Anderson when he did, step down from the Metamark board. Shine noted that she had no previous arrangement.

Senator not convinced

The limited waiver was criticized by U.S. Sen. Chuck Grassley, R-Iowa, who has investigated conflicts of interest in medicine and championed legislation to make ties more transparent.

In an email Tuesday, Grassley said "the onus" is on the UT System to explain how the "arrangements completely protect patients and the integrity of medical research."

"Even if Dr. DePinho's financial holdings are in a blind trust, the perception of bias by M.D. Anderson researchers toward companies co-owned by the boss could taint their research," Grassley wrote. "And why is it important for the head of M.D. Anderson to have been active in 'commercialization activities?'

"The emphasis on 'commercialization' is potentially inconsistent with the goal of treating patients, so the university should explain further how the public benefits."

UT System general counsel Barry Burgdorf said the blind trust plan will be selected by DePinho and reviewed by the system. He said there is no plan to make it a "double blind trust," in which neither the owner of the portfolio nor its new manager knows of the other.

Sheldon Krimsky, a Tufts University professor who writes frequently on conflicts of interest, said double blind trusts provide added protection. Krimsky said any blind trust is a step in the right direction by the UT System, but added that it's not the ideal solution.

"There shouldn't be the slightest appearance of conflict of interest in (DePinho's) holdings or board membership with any other activities occurring at the university," Krimsky said. "The gold standard is divestiture. A blind trust is second best."

Under Shine's decision, the manager of DePinho's blind trust will be able to sell stock but not buy it.